February 1, 2023

Many people have gone through the unfortunate experience of a wisdom tooth infection or at least know of someone, a relative or a friend, who has experienced such pain. Wisdom teeth infections are synonymous with excruciating pain, unpleasant visits to the dentist, operations and severe pain after such operations. Let us discuss why wisdom teeth get infected and how such a problem is usually treated.

To start off with, wisdom teeth are the molars which start to erupt at the very back of the dental arch, usually at the age of about twenty one. Not everybody has wisdom teeth; in fact a large portion of the population are born with congenitally missing wisdom teeth. In an even greater portion of people the wisdom teeth are present but never erupt, they remain in a so called ‘dormant’ state hidden beneath the level of the gums at the very back of the mouth. Lack of space for eruption is the reason for these teeth remaining unerrupted. As long as these unerupted wisdom teeth are completely embedded underneath the gums, they never give any problems because they are in a sterile environment where bacteria cannot penetrate.

Problems start to arise when wisdom start to erupt into space which is not big enough to accommodate the whole crown of the tooth; in many cases the wisdom tooth will be angulated and will become impacted or stuck behind the second molar. Since part of the tooth would have broken through the gums it then becomes susceptible to infections. This is because part of the tooth would become covered with flaps of gums which are difficult to clean and therefore serve as reservoirs for debris and bacteria. Long standing inflammation of the gums surrounding these partially erupted wisdom teeth may sometimes progress to an infection of the wisdom tooth, or as it is technically called, pericoronitis.

Patients suffering from such a condition experience severe pain of the associated side of the face, sometimes spreading to the ear and temporal region of the head. Swelling of the face due to accumulation of pus is also common, as is difficulty in opening the mouth and difficulty in eating. Ulceration of the gums overlying the affected wisdom tooth may also occur due to constant friction between these inflamed and swollen gums and the teeth in opposing dental arch.

Visiting a dentist is imperative when experiencing such symptoms; infections of lower wisdom teeth can sometimes be life threatening if left untreated since the swelling may spread to the airways and impede breathing. Treatment of these types of infections is split into two: the acute treatment phase (basically treating the infection which is causing pain), and the long term treatment phase (dealing with the wisdom tooth which caused the infection in the first place).

To treat the acute infection the patient is usually prescribed a broadspectrum antibiotic; this is sometimes given intravenously in a hospital setting in very severe cases. An antiseptic mouthrinse or gel is also recommended to help reduce the bacterial load around the infected wisdom tooth. And last but not least, good oral hygiene instructions should be provided to the patient so that he or she may clean the area of the infected wisdom tooth with a toothbrush and toothpaste to speed up the healing process.

Once the acute infection has healed, a process which usually takes five to six days, a decision is taken to either remove the wisdom tooth or to leave it in place. The dentist will ask questions during the first visit such as: Is this the first time that the patient has experienced such an infection of this particular tooth? Is the tooth erupting or is it impacted? Has this tooth got infected due to very bad oral hygiene? Can oral hygiene be improved thus preventing a future infection? Will removal of the tooth require surgery? These questions together with radiographic examination will help the dentist decide on which line of action to take.